What is the dosage of Augmentin (amoxicillin/clavulanate) for a 2-year-old child with otitis media (OM) weighing 35 kg?

Dosage of Augmentin for a 2-Year-Old with Otitis Media Weighing 35 kg

For a 2-year-old child with otitis media weighing 35 kg, the recommended dosage of Augmentin (amoxicillin/clavulanate) is 80-90 mg/kg/day of the amoxicillin component, divided into two doses, which equals approximately 1400-1575 mg twice daily. 1

Dosage Calculation

• For a 35 kg child, the appropriate dosage calculation is:

  • 80-90 mg/kg/day × 35 kg = 2800-3150 mg/day of amoxicillin 1
  • Divided into 2 doses = 1400-1575 mg per dose, given twice daily 1, 2

• For children weighing ≥40 kg, adult dosing would apply, but at 35 kg, pediatric weight-based dosing is still appropriate 2

Formulation Selection

• The appropriate formulation would be the high-dose amoxicillin/clavulanate suspension (typically 600 mg/5 mL or 400 mg/5 mL) 1, 2
• The 14:1 ratio of amoxicillin to clavulanate is preferred to minimize gastrointestinal side effects 1

Treatment Duration

• The recommended duration of therapy for acute otitis media is 10 days 2, 3
• Treatment should be administered at the start of a meal to enhance absorption of clavulanate and minimize gastrointestinal intolerance 2

Considerations for Treatment Selection

• Amoxicillin/clavulanate is indicated in the following scenarios:

  • If the child has taken amoxicillin in the previous 30 days 1
  • If the child has concurrent conjunctivitis (suggesting H. influenzae infection) 1
  • If the child attends daycare (higher risk of resistant organisms) 1
  • For moderate to severe illness 1

• For children with penicillin allergy:

  • If non-type I hypersensitivity reaction: cefdinir, cefpodoxime, or cefuroxime can be used 1
  • For type I hypersensitivity reactions: consult with specialist for alternative options 1

Monitoring Response to Treatment

• The child should begin to show clinical improvement within 24-48 hours of starting therapy 1
• If no improvement is seen within 48-72 hours, reassessment is necessary to:
  • Confirm the diagnosis of AOM
  • Consider changing the antibiotic 1

Common Pitfalls to Avoid

• Using standard-dose amoxicillin/clavulanate instead of high-dose formulation may be inadequate for resistant organisms 1, 3
• Twice-daily dosing is preferred over three-times-daily dosing as it:
  • Improves compliance 4, 5
  • Results in lower incidence of diarrhea (14% vs 34%) 2, 4
• Failure to administer with food increases the risk of gastrointestinal side effects 2

Additional Considerations

• Pain management should be addressed regardless of antibiotic use 1
• For children with vomiting or inability to tolerate oral medication, a single 50 mg/kg dose of ceftriaxone (IV or IM) can be given initially 1
• The twice-daily regimen of amoxicillin/clavulanate has shown equivalent efficacy to three-times-daily dosing with better compliance 4, 5